telehealth policy coalition meeting april 19, 2019 …...telehealth policy coalition meeting april...

Telehealth Policy Coalition Meeting April 19, 2019

MEETING NOTES

I. Overview of AB 744

Ms. Durbin provided an overview of AB 744. The bill is intended to ensure access to telehealth

by clarifying the existing laws so that a service is not treated differently due to being performed via

telehealth. Additionally, the bill makes technical updates to language, reflecting updates in telehealth

technology. The removal of asynchronous terminology was intended to be a technical correction to

eliminate redundancy. Ms. Durbin commented, however, that there have been concerns that omitting

the terminology could result in unintended consequences, therefore it will be amended back into the

language.

Additionally, AB 744 incorporates coverage language from the American Medical Association,

which has been adopted in 14 different states to spell out what terms and conditions should be included

in a contract. A cost benefit analysis of the bill, which excluded e-consult and remote patient

monitoring, suggested a cost of $270 million. CMS intended to discuss the full picture of cost savings

during the next committee hearing.

Ms. Durbin stated that the only opposition currently has been from health plans in the Chamber of

Commerce. She believes the opposition is due to assumptions surrounding the use of terms “same” and

“same extent” and clarified that the bill still allows for flexibility and renegotiation.

AB 744 also includes a punishment for noncompliance which would generate a fund. If the bill were to

use the existing fund, it would have resulted in a 2/3 vote in appropriations. A new fund was created to

avoid this. The first million dollars generated in this way would fund the Steven Thompson Physician

Corps Loan Repayment Program. Changes to the fund will be addressed in upcoming amendments of the

bill.

II. CCHP/BluePath Last 30 Days Policy Round-up

AB 848- Adds continuous glucose monitors to the schedule of benefits under Medi-Cal when

medically necessary for the treatment of diabetes. Subject to utilization controls and shall be

implemented only to the extent that federal financial participation is available. Passed Senate

Committee on Health and re-referred to Committee on Appropriations.

AB 1494- Would authorize, with federal financial participation and approval, that face-to-face

contact or physical presence of a Medi-Cal beneficiary in an enrolled community clinic not be needed to

receive services during a state of emergency. Bill was amended April 10th with clarifying language. Read

second time in Assembly Committee on Appropriations on April 11th.

AB 1529- Would require a telephone medical advice service to ensure services from a provider

in an out-of-state location are operating consistent with state licensing laws. Passed Assembly and sent

to Senate Committee on Rules for assignment on April 9th.

AB 1642- Originally required review by a contracted external quality review organization to

include extent to which Medi-Cal MCOs use telecommunications technology to meet network adequacy

standards. Amended on April 1st to also require Medi-Cal MCOs to provide additional information in its

request for alternative access standards (such as description of reasons justifying the alternative access

standards). Also in amendment: requires Medi-Cal MCOs to assist beneficiaries outside of distance and

time requirements in obtaining an appointment with an out-of-network provider. And increases the

maximum penalty for failing to provide medically necessary services under the contract to $100,000.

Passed Assembly Committee on Health on April 9th.

SB 24- Requires all state university health clinics to offer abortion by medication techniques by

2023. Makes available the College Student Health Center Sexual and Reproductive Health Preparation

Fund to fund the services, which may include telehealth. Set for hearing in Senate on April 24th.

SB 612- Requires health care service plans, including Medi-Cal MCOs, to report on their

participation in specified activities, including services offered in non-traditional settings such as through

telehealth. Set for hearing with Senate Committee on Appropriations on April 29th.

Ms. Kwong also provided a brief update regarding the DHCS policy updates. DHCS says the final

version is still set to be released in Spring. The major components of the proposal seem to be intact.

There has been some conflicting information regarding what constitutes a Medi-Cal enrolled provider.

While unconfirmed, there may be changes made to the FQHC policy, affecting home as an originating

site.

Ms. Kwong also provided a brief overview of the current status of the CMS final rule regarding

telehealth benefits for MA plans. The rule tells MA plans that if a service fits the delivery model, it can

be delivered through telehealth. However, MA plans do not need to take advantage of the increased

flexibility. Services are still limited by a list of providers, which does not include allied health

professionals.

Finally, there was an update regarding the Congressional Telehealth Caucus’ request for

information. CCHP submitted comments to the caucus, which included the following points:

• Remove the geographic requirement on the originating site

• Expand the list of eligible locations where telehealth encounters may take place in the

Medicare program

• Expand the list of eligible modalities

• Expand the list of eligible services Medicare will reimburse for if the service is delivered

via telehealth

• Expand the list of eligible providers who can provide and be reimbursed for telehealth-

delivered services

• Provide more flexibility to CHCs to utilize telehealth

• Remote patient monitoring

• Clear, consistent policies

• Telehealth Resource Centers funding needs to be increased to meet the increased

demand and ensure unbiased, accurate information and education is provided

III. Telehealth Coalition Survey and Interview Findings

Ms. Sagara provided an overview of the survey and interview results. Initial takeaways

suggested that coalition members want to see the following:

Coalition Objectives

1. Legislator/regulator education and/or liaising

2. Law and policy implementation and tracking

3. Model law and policy development

4. Active voice on mutually agreeable telehealth legislation

Priority Policy Topics

1. Increased coverage for telehealth

2. Reimbursement parity

3. Increased awareness of telehealth

4. High interest in geriatrics, pediatrics, general specialty and mental health

Additional considerations

1. Broad and inclusive definition of telehealth

2. Desire to convene in an annual meeting

3. Featuring SMEs on monthly coalition calls

4. Possible expansion of membership

5. Potential to move monthly calls to Friday mornings

Ms. Sagara also mentioned that the coalition may want to determine what kind of tools can be

developed in the future, including a quarterly newsletter, weekly policy roundup, a telehealth coalition

website, telehealth legislative briefing, or a telehealth coalition annual meeting.

IV. Additional News and Announcements

Ms. Kwong briefly mentioned a recent case where Federal prosecutors charged 24 people in an

alleged $1.2 billion Medicare fraud scheme involving telemedicine. She mentioned that the case may

result in questions regarding how telehealth can protect against fraud and suggested the coalition and

its members develop an answer to such questions.

CCHP serves as the convener of the Telehealth Policy Coalition monthly conference calls. The purpose of these calls

is to share relevant information and provide a forum for strategy discussions.

California Telehealth Policy CoalitionMonthly Call

April 19, 2019

AgendaIntroductions and Agenda Overview 5 min

Legislation Committee• Overview AB 744: Amy Durbin, CMA• State Updates• Federal Updates

• CCHP Letter to Congress

20 min

Education Committee• Education Committee Update

5 min

2019 Coalition Objectives and Priorities - Discussion• Summary of Coalition Member Surveys• Initial Member Interview Takeaways• Communication Planning

20 min

News and Announcements 5 min

Wrap up 5 min

http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB744

Overview of A.B. 744

Amy DurbinAssociate Director, Government AffairsCalifornia Medical Association

Legislation Committee and State Updates Telehealth bill updates:

Upcoming hearings:— April 22: Assembly Health, Informational Hearing— April 23: Assembly Health, Bill Hearing (inc. A.B. 744 (payment parity), A.B. 1676 (provider to provider mental

health consults)— April 25: Senate Budget and Fiscal Review Subcomm. 3, Informational Hearing— April 30: Joint Oversight Hearing, Preventive Services for Children in Medi-Cal

DHCS Telehealth Update: DHCS anticipates publishing the new Telehealth Provider Manual and All Plan Manual in late spring

Bill Brief Summary Developments

A.B. 848 Medi-Cal coverage of blood glucose monitors and related supplies

• Passed Assembly Health 3/26

A.B. 1494 FQHC and RHC reimbursement for telehealth during emergencies • Passed Assembly Health 4/9• Amendment, 4/11: specifies that ”premises”

includes sites outside four walls of FQHCs for the delivery of telehealth services

A.B. 1529 Reiteration that out of state providers providing medical services over phone are subject to state licensing boards

• Passed Assembly Business & Professions 4/2• Passed Assembly 4/8

A.B. 1642 Medi-Cal MCPs must provide beneficiaries with non emergency medical transportation, actuarial rate methodology if alternative access standards are approved (telehealth is allowed for alternative access)

• Passed Assembly Health 4/9

S.B. 24 Medication abortion requirement for UC/CSU; start up funding can be used for telehealth purposes

• Passed Senate Health 4/3

S.B. 612 Health plan reporting on services and supports not geographically located near beneficiaries, including telehealth

• Passed Senate Health 4/10

Federal Updates

Mental Health Telemedicine Expansion Act— Introduced by Sen. Kamala Harris in late 2018; companion bill H.R. 1301 introduced

by Reps. Suzan DelBene and Tom Reed— Would expand access to telemental health benefits beyond those currently allowed

under law according to originating site and geographic region— For more information, please see APA fact sheet, attached to today’s materials

CMS Final Rule Regarding Telehealth Benefits for MA Plans — Plans may now propose including additional telehealth benefits beyond the

restrictive FFS geographic and originating site limitations— Plans may now include a more telehealth benefits as basic benefits, not just as

supplemental benefits— For more information, please see CCHP Fact Sheet, attached to today’s materials

https://www.cchpca.org/sites/default/files/2019-04/MA%20PLAN%20CMS%20FINAL%20RULE%202019%20FINAL.pdf

Congressional Telehealth Caucus Request for Information, CCHP ResponseBelow are CCHP’s key points in its response to the Congressional Telehealth Caucus’ RFI, focused on Medicare policy.

Remove the geographic requirement on the originating site

Expand the list of eligible locations where telehealth encounters may take place in the Medicare program

Expand the list of eligible modalities

Expand the list of eligible services Medicare will reimburse for if the service if the service is delivered via telehealth

Expand the list of eligible providers who can provide and be reimbursed for telehealth-delivered services

Provide more flexibility to CHCs to utilize telehealth

Remote Patient Monitoring

Clear, Consistent Policies

Telehealth Resource Centers funding needs to be increased to meet the increased demand and ensure unbiased, accurate information and education is provided

Education Committee Update

Discussion of Telehealth Coalition Member Interview FindingsObjectives:

• Further understanding organizations’ definition of telehealth

• Understanding organizations’ views of the Coalition’s role in advancing telehealth policy

• Capturing organizations’ telehealth interests

• Capturing organizations’ objectives and priority focus areas

• Determining appetite for in-person meetings

• Identifying other organizations for outreach

Timeline: March 8 to April 3

Number of interviews: 16

See appendix for full list of interview questions

Client Proprietary and Business Confidential 9

What we heard – Member Survey and Initial Interview Responses

Coalition Objectives

• Legislator/regulator education and/or liaising• Law and policy implementation and tracking• Model law and policy development• Active voice on mutually agreeable telehealth legislation

Priority Policy Topics

• Increased coverage for telehealth• Reimbursement parity• Increased awareness of telehealth• High interest in geriatrics, pediatrics, general specialty and mental health

Additional Considerations• Broad and inclusive definition of telehealth• Desire to convene in an annual meeting• Featuring SMEs on monthly coalition calls• Possible expansion of membership• Potential to move monthly calls to Friday mornings


Next Steps for Stakeholder EngagementTaking into account your recommendations, we will be conducting a second round of interviews with organizations not currently part of the Coalition. Below is a list of organizations to be engaged through mid-May.Health Plans/Trade Associations

Anthem

California Health & Wellness/Health Net

Kaiser Permanente

Promise Health Plan

San Francisco Health Plan

California Association of Health Plans

Local Health Plans of California

Vendors

mPulse

Rubicon MD

Safety Net Connect

Teladoc

Vsee

Providers/Trade Associations

Ampla

Beacon Health Options

Community Health Center Network

Tarzana Treatment Centers

Telemed2U

UC Office of the President

America’s Physician Groups

California Association of Public Hospitals

California School-Based Health Alliance

Purchasers

CalPERS

Covered California

Pacific Business Group on Health


Draft High-Level Communication Plan Communication Tool Purpose Audience Timing

Quarterly Newsletter • Aggregate developments in CA policy and legislation

• Celebrate Coalition Activities/Success

• Reinforce Coalition Identify

Members and expanded list of contacts interested in telehealth policy

Quarterly

Weekly Policy Roundup

Provide up-to-date activity in CA and Federal telehealth policy that requires action by or attention from the coalition

Members and expanded list of contacts interested in telehealth policy

Weekly

Telehealth Coalition Web Site

Serve as a repository for California-specific telehealth law, policy and research, and track legislative and regulatory developments

Members and expanded list of contacts interested in telehealth policy, policymakers, telehealth implementers or policy stakeholders

Launch summer 2019, update as needed

Telehealth Legislative Briefing

Gather state health care stakeholders at a Capitol briefing in summer 2019 to share current/pending telehealth legislation, future needs and priorities

Members, policy makers, Capitol staffers

Summer 2019 (leg break)

Telehealth Coalition Annual Meeting

Network, share knowledge, discuss policy needs and priorities for 2020

Members and key stakeholders selected by the coalition to be invited (e.g. 50 max)

November 2019


Timeline of Potential Activities

Activity Date(s)

Interviews with additional stakeholders April through mid-May

May Coalition Meeting

• Present findings from additional stakeholder feedback

• Review final draft of charter

May 17

Begin publishing quarterly newsletter June 2019

Ongoing Coalition Meetings June through December 2019

Build-out and Update Telehealth Coalition web site July 2019

Telehealth Coalition Legislative Briefing Summer (TBD)

In-Person Meeting to Review 2019 and Plan for 2020 November 2019

News and Announcements

Federal prosecutors on Tuesday said they dismantled one of the largest health carefraud schemes ever investigated by the FBI, charging 24 people in a $1.2 billion alleged scam involving telemedicine and durable medical equipment companies.

Key Points:

Accused include 5 telemedicine companies, 130 DME companies and 3 licensed medical professionals

Fraud initiated by call center “upselling” of unnecessary medical equipment

Call centers bribed telemedicine companies to pay doctors to write fraudulent equipment and Rx orders

Call centers sold orders to DME companies and billed Medicare, with hundreds in kickbacks per order

https://www.npr.org/2019/04/10/711688988/feds-charge-24-in-alleged-1-2-billion-medicare-fraud-scheme

https://www.npr.org/2019/04/10/711688988/feds-charge-24-in-alleged-1-2-billion-medicare-fraud-scheme

News and Announcements

Upcoming CHCF Briefing: Improving Quality of Care for Californians in Medi-Cal Managed Care

—Monday, April 29 from 10:00-1:00, Sacramento—Presentations will include analysis of Medi-Cal managed care trends, ideas

for quality improvement in Medi-Cal managed care, and recommendations for using quality measures as part of financial incentive programs

—For more information and to register, please see the CHCF website

Upcoming CHCF Briefing – Expanding the Role of Nurse Practitioners—Monday, May 6 from 12:00-1:30, Sacramento—CHCF will be bringing in experts from other states that have expanded

scope of practice authority for NPs—For more information and to register, please see the CHCF website

https://www.chcf.org/event/briefing-improving-quality-medi-cal-managed-care/

https://www.chcf.org/event/briefing-expanding-role-nurse-practitioners/


Appendix


Telehealth Coalition Members Interviewed

• Julie Bates, AARP

• Peggy Broussard-Wheeler, California Hospital Association

• Joy Burkhard, 2020 Mom

• Fabiola Carrion, National Health Law Program

• Bryce Docherty, KP Public Affairs

• Amy Durbin and Lisa Matsubara, California Medical Association

• Jana Katz-Bell, Dr. James Marcin, UC Davis Health

• Erin Kelly, Children’s Specialty Care Coalition

• Michael Kurliand, West Health

• Samrina Marshall, The MAVEN Project

• Yamilett Medrano, Loma Linda University

• Aracely Navarro, The Children’s Partnership

• Dr. Larry Ozeran, Clinical Informatics

• Vivian Thomas, California Department of Public Health

• Dr. David Wetherhold and Amber Ter-Vrugt, Scripps Health

• Carol Yarbrough and Lisa Deangelis, UCSF Health


Bill No. Title Details Recent Updates, Notes

A.B. 156(Voepel)

Eye care: remote assessment

• Would prohibit use of virtual eye exams unless certain prescribed requirements are met

A.B. 385(Calderon)

Medi-Cal: EPSDT mental health services

• Requires DHCS to create quality performance measurement system for mental health services within CHIP ESPDT

• Requires DHCS to convene stakeholder group

Passed Asm. Health 4/9Opportunity to advocate for telehealth measures

A.B. 537(Wood)

Medi-Cal Managed Care: QI and value based incentive program

• Requires DHCS to establish quality assessment and performance improvement program and value-based to ensure Medi-Cal MCPs achieve minimum performance level

Passed Asm. Health 4/9Opportunity to advocate for telehealth measures

A.B. 744(Aguiar-Curry)

Health care coverage: telehealth

• Requires payment parity for telehealth services for all DOI and DMHC regulated products (including Medi-Cal Managed Care)

• Amends definition of asynchronous telehealth to S-A-F• Prohibits annual and lifetime limits on telehealth• Prohibits separate telehealth cost-sharing requirements not imposed on

non-telehealth benefits• Removes Medi-Cal requirement that individuals be able to request in-

person consult w/ distant site provider for teleoph., teledentistry, telederm.

A.B. 848(Gray)

Medi-Cal: covered benefits: continuous glucose monitors

• Would require Medi-Cal cover continuous glucose monitors and related supplies

Passed Asm. Health 3/26

Telehealth-Related Bills – To be updated

https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB156







A.B. 1494 (Aguiar-Curry)

Medi-Cal: telehealth: state of emergency

• Requires DHCS to reimburse FQHCs and RHCs for covered services provided via telehealth following declaration of state of emergency, regardless of whether patient is physically located at clinic, or whether existing provider-patient relationship exists


A.B. 1529(Low)

Telephone medical advice services

• Would specify that out of state health professionals providing medical advice over the phone are subject to licensing laws of the various boards in California, not just the DCA

Passed Asm. B&P 4/2Passed Asm. 4/8

A.B. 1642 (Wood)

Medi-Cal: managed care plans

• Requires MMC plans to provide DHCS with justification for requesting alternative access standards; must arrange for non-emergency medical transportation if alternative access standards are approved

• Requires actuarial rate methodology to include beneficiary access to Medi-Cal covered services, including travel times to receive services, and the ability of a Medi-Cal MCP to comply with the time and distance req’ts w/o seeking authorization to adopt alternative access standards

• Authorizes DHCS to impose fines of up to $100K if plan fails to provide medically necessary services that the contractor is required to provide to an enrollee covered under the contract


A.B. 1676 (Maienschein)

Health care: mental health

• Requires DOI and DMHC regulated products to establish telehealth consultation programs to diagnose and treat child and postpartum mental illness

• Requires communication 2x per year to enrollees regarding programs• Requires plans to keep utilization records


http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200AB1494






A.B. 1689 (McCarty)

College Mental Health Services Program

• Establishes grant program for community college, UC, CSU mental health programs

• Requires submission of program evaluation to the state regarding state-funded mental health programs

• Opportunity to promote use of telehealth to increase access to college mental health services


S.B. 12 (Beall)

Mental health services: youth

• Would create Integrated Youth Mental Health Programs with sites across the state based on headspace model using MHSA dollars

• Headspace model on which this is based includes telehealth

Passed Senate Health 3/27Passed Senate Appropriations 4/8

S.B. 24 (Leyva)

Public health: public university student health centers: abortion by medication techniques

• Requires health clinics on UC and CSU campuses to offer medication abortions onsite

• Established College Student Health Center Sexual and Reproductive Health Preparation Fund to provide private monies to public university health centers for medication abortion readiness

• Grants each campus $200K for readiness assessments, including determining costs associated w/ using telehealth to provide abortions

• Grants each campus $200K for direct and indirect costs that can be used to establish a corporate account to provide telehealth services

Passed Senate Health 4/3

S.B. 66(Atkins and McGuire)

Medi-Cal: FQHCs and RHCs

• Would allow for max. of 2 visits per day to FQHC or RHC under PPS rate if second visit is for mental health or dental visit

• Opportunity to advocate for visits to be via telehealth, and not just in-person

Passed Senate Health 3/20Passed Senate Appropriations 4/8



https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB12

http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB24&search_keywords=abortion%23%23%23telehealth

https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB66



S.B. 612 (Pan)

Health care data reporting

• Requires DOI and DMHC regulated products and medical groups to report to OSHPD on services and supports that are geographically located close to enrollees, or that are offered nontraditional settings, such as telehealth

Passed Senate Health 4/10


http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB612


Interview Questions

• Please provide an overview of your organization’s background populations served (Medi-Cal FFS, Medicare, etc.) and describe your role.

• When and why did you get involved with the California Telehealth Policy Coalition?

• What is the role the Coalition is playing today, and what role do you believe the Coalition should play in the future? (This year, 2-3 years, 5 years)

• What should be the Coalition’s mission? Do you agree with the proposed mission and vision, described below?

• Please confirm your organization’s definition of telehealth. (Most do not have a definition.)

• Confirm priority objectives for the Coalition• Please describe why your organization prioritizes these objectives over others in 2019?• What outcomes do you seek within these priority areas? How would you measure success?• What specific actions do you believe the Coalition should facilitate to achieve these desired

outcomes?• What specific actions do you believe the Coalition should facilitate to achieve these desired

outcomes?• Do you have specific interest in working with the Coalition and other Coalition members

around these objectives? Please describe how you see you and/or your organization may contribute.


Interview Questions

• Confirm telehealth topic priorities (expanded reimbursement, reimbursement parity, etc.)• Please describe why your organization prioritizes these topics.• Do you have specific interest in working with the Coalition and other Coalition members around

these objectives? Please describe how you see you and/or your organization may contribute.

• Have you or are you planning to advance telehealth related language in legislative bills this year or next? Please describe.

• Are there existing bills you are monitoring closely?

• Do you or your organization have telehealth educational materials that you believe other members of the Coalition would find helpful?

• Are there educational materials or others you would find helpful to be developed or shared by others?

• Confirm in-person meeting response.• What’s the best time of year/day of week for you to attend an in-person convening?

• Are there organizations you recommend we reach out to that might be interested in participating with the Coalition’s efforts? Your community, peer or collaboration partners?

• What kind of regular communications would you like to see?


Review of Telehealth Coalition Member Survey Responses

Objectives:

• Refining/aligning definition of telehealth

• Capturing organizations’ telehealth interests

• Capturing organizations’ objectives and priority focus areas

• Determining appetite for in-person meetings

• Determining willingness for follow-up interviews

Timeline: Open from February 22 to March 8

Respondents: 21 out of 109 members

See appendix for full list of survey questions


Survey Results

The vast majority of members’ organizations (over 60%) have not adopted the Business and Professions Code definition of telehealth.

Use B&P definition.

Does not have a definition of telehealth.

Don’t know/not

sure.

Use another definition.


Survey Results

Members largely assign equal weight to each of the proposed Coalition’s objectives on average, but more highly prioritize legislator/regulator education and/or liasinig to discuss issue, legal/policy implementation tracking, and model law and/or policy development.


Survey Results

Members assign slightly more priority to the telehealth topics increased coverage of telehealth services, reimbursement parity, and increased awareness of telehealth.


Survey Results

Older adults, pediatric/ adolescent health, general specialty care, and mental health are the top four populations/ specialties of interest.


Survey Results

Medi-Cal is the primary coverage type represented by members/ primary recipient of their services, followed by employer/group and individual market.


Survey Results

Over 90% of members are interested in an in-person meeting at the end of the year.

telehealth policy coalition meeting april 19, 2019 …...telehealth policy coalition meeting april...

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